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Hereditary Spastic Paraparesis


Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Jun 2021| Content last modified Jun 2021

Hereditary (familial) spastic paraparesis is a group of rare hereditary disorders that cause gradual weakness with muscle spasms (spastic weakness) in the legs.

  • People with hereditary spastic paraparesis have exaggerated reflexes, cramps, and spasms, making walking difficult.

  • Doctors look for other family members who have the disorder, rule out disorders that can cause similar symptoms, and may do genetic tests.

  • Treatment includes physical therapy, exercise, and drugs to reduce spasticity.

Hereditary spastic paraparesis affects both sexes and may begin at any age. It affects about 1 to 10 of 100,000 people.

This disorder has many forms and can result from many different types of genetic abnormalities. All forms cause degeneration of the nerve pathways that carry signals from the brain down the spinal cord (to muscles).

More than one area of the spinal cord may be affected.


Symptoms of hereditary spastic paraparesis may begin at any age—from age 1 to old age—depending on the form.

Reflexes become exaggerated, and leg cramps, twitches, and spasms occur, making leg movements stiff and jerky (called a spastic gait). Walking gradually becomes more difficult. People may stumble or trip because they tend to walk on their tiptoes with the feet turned inward. Shoes are often worn down in the area over the big toe. Fatigue is common. In some people, muscles in the arms also become weak and stiff. Sensation and bladder and bowel function are usually not affected.

Usually, symptoms continue to slowly worsen, but sometimes they level off after adolescence. Life span is not affected.

Many forms of hereditary spastic paraparesis damage other parts of the body in addition to the spinal cord. These forms may cause other problems, such as eye problems, lack of muscle control, hearing loss, intellectual disability, dementia, and peripheral nerve disorders Overview of the Peripheral Nervous System The peripheral nervous system refers to the parts of the nervous system that are outside the central nervous system, that is, those outside the brain and spinal cord. Thus, the peripheral nervous... read more .


  • Exclusion of other disorders with similar symptoms

  • Identification of family members with the disorder

  • Sometimes genetic tests

Blood tests to check for the genes that cause the disorder (genetic testing) are sometimes done.


  • Physical therapy and exercise

  • A drug to reduce spasticity

Treatment of all forms of hereditary spastic paraparesis focuses on relieving symptoms.

Physical therapy and exercise can help maintain mobility and muscle strength, improve range of motion and endurance, reduce fatigue, and prevent cramps and spasms.

Baclofen (a muscle relaxant) is the drug of choice to reduce spasticity. Alternatively, botulinum toxin (a bacterial toxin used to paralyze muscles or to treat wrinkles), clonazepam, dantrolene, diazepam, or tizanidine may be used.

Some people benefit from using splints, a cane, or crutches. A few people require a wheelchair.

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Test your knowledge
Muscle Cramps
A cramp is a sudden, involuntary, and usually painful contraction of a muscle or group of muscles. Which of the following is the most common cause of muscle cramps?
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